Swivel tube connections with hermetic seals

ABSTRACT

Apparatus and methods are disclosed by which a closed ventilating system accommodates multiple access to the respiratory system of an intubated medical patient without compromising the closed character of the system. Access to the respiratory system through one or more access sites of the closed system apparatus is provided at proximal adapter ports to ventilate the lungs of the patient with gas or gases, to aspirate secretions from the lungs, to oxygenate the lungs to eliminate or reduce residual co 2  therefrom, to visually inspect selected parts of the respiratory system, to sample sputum and gases, to sense parameters such as flow rates, pressure, and temperature, to flush with washing solution, and/or to administer medication, gases, and/or lavage. A distal swivel fitting provides multiple sealing sites by which entry of atmosphere is prevented.

RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 08/245,333 filed May 18, 1994, now abandoned, entitled "MedicalMultiple Access Low Dead Space Anti-Microbial Aspirating/VentilatingClosed System Improvements and Methods".

FIELD OF INVENTION

The inventions disclosed herein relate generally to improved medicalcare for intubated patients, and more particularly to novel low deadspace improvements, and related methods, for ventilating, aspirating,monitoring, sampling, and providing therapeutic delivery to therespiratory tract of intubated medical patients, including infants,adolescents, and adults.

BACKGROUND

Respiratory patient care is a dynamically developing field in medicine,ranging in its needs from infants to the aged. The range of respiratoryailments, both temporary and permanent, to which such patients aresubjected are many and varied. The frontier of medical knowledge isadvancing and recommended treatments have become a blend of old and morerecent discoveries.

Most problems now center or focus on multiple needs of the patient andaccommodation of multiple treatments, some to be performed at the sametime. The lack of equipment to facilely, efficiently, and safelyaccomplish the multiple therapies in the best interest of the patienthas been and continues to be a concern. Other equipment problems alsoexist which concern preventing cost-oriented, unsafe extended use ofventilating, aspirating, and other respiratory access apparatus,reliability during use, quick and reliable removal and exchange of spentaspirating and ventilating devices without compromising the quality ofhealth care provided to the patient, avoiding intentional or inadvertentconversion from a closed system to an open system, prevention of stressand/or occlusion of flow passageways to and from the patient'srespiratory system, avoidance of a large inventory of a variety ofincompatible products, providing easy, fail-safe access for multiplepurposes.

By way of an example only, with low lung capacity patients, such aspremature babies and adults suffering from emphysema, one problem is theremoval of accumulated lung secretions without starving the patient foroxygen (thereby causing undesirable side effects) during the secretionremoval process.

Sight must not be lost as to the deficiencies in prior proposals interms of risks created for the health care provider. Largely, proposalsof the past have ignored the needs of the health care provider to attaina reasonable measure of protection from contamination by the patient.

Providing apparatus and methodology having the capacity to promptly,efficiently, safely, and cost effectively address the health care needsof intubated patients across the entire spectrum of respiratory ailmentscomprises, prior to the present invention, a largely unresolved need.The range of procedures comprise: ventilating, aspiration, oxygenation,sampling, visual inspection, in-line sensing, pressure monitoring,flushing, and medication and/or lavage. Better protection for the healthcare provider has been a long-term unsatisfied need.

BRIEF SUMMARY AND OBJECTS OF THE PRESENT INVENTION

In brief summary, the present invention substantially alleviates theaforesaid problems of the prior art and comprises apparatus and methodsby which a closed ventilating system accommodates multiple access to therespiratory system of an intubated medical patient without compromisingthe closed character of the system. Access to the respiratory systemthrough one or more access sites of the closed system apparatus isprovided to ventilate the lungs of the patient with gas or gases, toaspirate secretions from the lungs, to oxygenate the lungs to eliminateor reduce residual co₂ therefrom, to visually inspect selected parts ofthe respiratory system, to sample sputum and gases, to sense parameterssuch as flow rates, pressure, and temperature, to flush with washingsolution, and/or to administer medication, gases, and/or lavage.

The system can be unitized into severable and disposable componentswhich are cost effective and accommodate good health care practiceswhile promoting limitations on duration of use well within appropriatemedical tolerances. Quick removal and replacement of discardedcomponents is accommodated without introduction of additional risks tothe patient. The technology of the present invention has substantialuniversal application to all respiratory patients, ranging from infantsto the aged. Swivel fittings or adapters, in the form of an elbow orother configuration, provide dual or multiple fail safe sealingstructure.

With the foregoing in mind, it is a primary object of the presentinvention to substantially alleviate problems of the prior art in thefield of respiratory care for medical patients.

It is an additional dominant object of the present invention to provideapparatus and related methods by which a closed ventilating system isable to accommodate multiple access to the respiratory system of anintubated medical patient.

An additional paramount object is the provision of novel apparatus andrelated methods by which a closed ventilating system accommodatesmultiple access to the respiratory system of an intubated medicalpatient without compromising the closed character of the system.

An additional object of the present invention is the provision of accessthrough one or more access sites in a closed system respiratoryapparatus to accommodate ventilating of the lungs of the patient withgas or gases, to aspirate secretions from the lungs, to oxygenate thelungs to eliminate or reduce residual carbon dioxide therefrom, tovisually inspect selected parts of the respiratory system, to samplesputum and gases, to sense parameters such as flow rates, pressure, andtemperature, to flush with washing solution and/or to administermedication, gases, and/or lavage, and related methods.

An additional significant object is the provision of a closedrespiratory health care system unitized into severable and disposablecomponents which are cost effective and accommodate good health carepractices while promoting limitations on duration of use well withinappropriate medical tolerances.

It is an additional valuable object to provide for quick removal andreplacement of discardable components toward the end of their usefullife in a respiratory health care system and to accommodate such withoutintroduction of additional risks to the patient.

It is another dominant object to provide a respiratory health caresystem and related methods which has substantial universal applicationto all respiratory patients ranging from infants to the aged.

A further important object of the present invention is to providefeatures in a respiratory health care system which avoid imposition ofstress on the components and prohibit occlusion of flow pathways.

It is a prominent object of the present invention to provide respiratoryhealth care systems and related methods which accommodate simultaneousaccess to and treatment within the respiratory system of a medicalpatient.

It is a further object of the present invention to provide novelrespiratory health care systems and related methods having minimal deadspace.

It is another paramount object to provide novel fittings and/or adapterswhich accommodate stress relief rotation and/or structure dual ormultiple fail safe sealing between the closed interior of the fitting oradapter and the atmosphere, and related methods.

These and other objects and features of the present invention will beapparent from the detailed description taken with reference to theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a fragmentary cross-section of one aspirating/ventilatingapparatus embodying principles of the present invention;

FIG. 2 is a side elevation of the distal fitting or adapter of theapparatus of FIG. 1.

FIG. 3 is an exploded longitudinal cross-section through the distalfitting or adapter of FIG. 1, showing the components of the adapter intheir disassembler or prior-to-assembly condition;

FIG. 4 is a cross-section of the dual seal features of the distalfitting or adapter of the apparatus of FIG. 1;

FIG. 5 is an enlarged fragmentary cross-section of the dual sealconstruction of the distal adapter or fitting prior to assembly; and

FIG. 6 is an enlarged fragmentary cross-section of the assembled dualseal construction forming a part of the distal adapter or fitting.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENT

Reference is now made to the drawings wherein like numerals are used todesignate like parts throughout. FIG. 1 illustrates in longitudinalcross-section a multi-access apparatus, generally designated 30, for usein conjunction with the respiratory tract of an intubated medicalpatient ranging from infants to the aged. The apparatus 30 comprises asingle distal access port 32 and a plurality of proximal access ports 34and 36. For example only, access ports 32 and 36 accommodate continualcyclic patient ventilation, independent of pursuit by the health careprovider of any other patient respiratory access procedure. Access port34 accommodates selective insertion and subsequent removal of anaspirating catheter assembly, the catheter tube of which may be used toremove secretions from the lungs, to replace residual carbon dioxide inthe lungs with oxygen, to accommodate entry of temperature or pressuremonitoring instruments or to accommodate obtaining samples of sputum orgases and/or to allow insertion of visual inspection instruments.

The apparatus 30 comprises a tracheal tube adapter, generally designated44, preferably formed of injection molded rigid medical grade syntheticresinous material, such as acrylic, cyrolite, pebax, polypropylene, orthe like. While any suitable adapter shape could comprise the distalfitting of the apparatus 30, the shape illustrated is that of an elbow.Adapter 44 comprises dual fitting, each comprising a hollow femaledistal bell housing, generally designated 46, which comprises a steppedannular wall 48.

Wall 48 comprises a thickness which is generally uniform, defined byinside and outside surfaces 50 and 52. The distal end of wall 48 isdefined by a blunt transverse annular distal edge 54, where the bellhousing comprises its largest diameter. Wall 48 comprises a firstreduced diameter annular step 56 comprising inside shoulder 58, and asecond further reduced diameter annular step 60.

Referring also to FIG. 6, annular step 60 defines a trifurcation wheredual annular swivel alignment-retaining and sealing walls 62 and 63extend distally from the juncture sites with wall 48 adjacent step orshoulder 60. Walls 48, 62, and 63, where co-extensive, are separated byblind annular slots 66 and 67 which open distally. Walls 48, 62, and 63are illustrated as being formed as one-piece. Wall 62 comprises aninterior surface 64, illustrated as being of uniform diameter, and ablunt annular transverse distal edge 61. Wall 48 proximal of shoulder 60comprises exterior annular wall 69. Central wall 63 is annular andcomprises inside and outside surfaces 70 and 72, respectively, ofuniform diameter. Wall 63 terminates in a converging double beveled orpointed end 74.

Adapter 44 also comprises a second bell housing, generally designated80, which is constructed to comprise components substantially the sameas bell housing 46, although bell housing 80 is somewhat shorter in itsaxial length. Accordingly, the parts of bell housing 80 have beenenumerated the same as bell housing 46 and no further description isneeded for one skilled in the art. Bell housing 80 is illustrated asbeing disposed generally at 90 degrees to bell housing 46 in theillustrated elbow configuration. The dual or multiple seal structurementioned above and shown best in enlarged fragmentary cross-section inFIGS. 5 and 6 creates four seal sites 20, 22, 24, and 26 (FIG. 6) at thetips of the blunt edges 96 and 97 of the double male prong 102 and 103upon entry into female blind slots 66, 67. As illustrated in FIG. 6, asdouble male prong or sealing ribs 102 and 103 enter female blind slots66 and 67, they are deflected in a radial direction. This causes them tocontact the adjacent walls and form sealing sights 20, 22, 24, and 26.

Wall 62 of bell housing 46 and wall 62 of bell housing 80 merge at site82, where a passageway 86 comprising port 34 merges with a passageway 84comprising port 32.

A swivel sleeve, generally designated 88, is rotatably positioned andsecured within the bell housing 46. Sleeve 88 comprises an annular wall90 comprising an interior surface 92, which is generally annular, butmay be slightly divergently tapered from left to right, as viewed inFIG. 1, to accommodate a press-fit but removable union with a proximalfitting of a tracheal tube 89, for example, in a manner generallywell-known to those skilled in the art. Sleeve 88 also comprises apredetermined length between blunt edge 94 at one end and blunt edges 96and 97 at the other end. Edge 94 extends distally a short distancebeyond edge 54. Edges 96 and 97 extend respectively, into slots 66 and67, adjacent to the shoulder 60.

Sleeve 88 also comprises an outside surface 98, which is interrupted byan outwardly directed radially-extending retaining flange 100. Thelocation of flange 100 is selected to be adjacent step or shoulder 56 toaccommodate rotation contiguous with shoulder 58. Sleeve 88 alsocomprises a pair of spaced relatively thin integral annular sealing ribor fingers 102 and 103 which sealingly fit into blind slots 66 and 67,respectively, when assembled. Ribs 102 and 103 extend proximally in anaxial direction.

When sleeve 88 is assembled into the position illustrated in FIG. 1, thesealing ribs 102 and 103 are, respectively, caused to forcibly engagethe annular surfaces defining slots 66 and 67 to thereby hermeticallyclose, at two spaced locations each, the interface between sleeve 88 andbell housing 46.

Sleeve 88 is retained in the position illustrated in FIG. 1 by anannular rigid plastic collar 104 positioned between walls 48 and 90 anddistally terminated in a radially directed distal flange 105. Thetrailing edge 107 of flange 105 is radially flush with edge 94, whileleading edge 109 of flange 105 is radially flush with and abuts edge 54.Collar 104 is bonded to surface 106 of wall 48. Thus, collar 104functions as a bushing with flange 100 rotatably engaging the edges 58and 113.

Sleeve 88', which is rotatably coupled to bell housing 80, issubstantially identical to sleeve 88, being rotatably placed within bellhousing 80. Sleeve 88' is enumerated identical to sleeve 88, although itwill be readily apparent that the sleeve orientation is reversed, theoverall length of sleeve 88 is shorter, the sleeve 88' extends beyondbell housing 80 and the radial flange 100 is positioned closer to slot63.

Ventilating tubing 89' is compression fit into or over the exposedsurface 115 of sleeve 88'. A tracheal fitting 88' is inserted into thehollow of sleeve 88. Sleeve 88' rotates with any rotation imposed uponthe connected ventilating tubing or, alternatively, retain anessentially stationary position if and when the adapter 44 is rotated,either intentionally or inadvertently in respect to sleeves 88 and 88'.Thus, twisting and consequential occluding or partial occluding ofventilating tubing is avoided.

Adapter 44 further comprises a proximally-directed barrel, generallydesignated 110. Proximally-directed barrel 110 comprises an annular wall112, the exterior surface 114 of which is annular, while the interiorsurface 117 is illustrated as being slightly tapered divergently in adistal direction to receive, in compression-fit relation, an aspiratingcatheter cartridge, generally designated 116. Cartridge 116 will beexplained in greater detail hereinafter.

The interior surface 117 defines a proximal passageway, the diametralsize of which is substantially smaller than either of the two previouslydescribed passageways 84 and 86. Wall 112 merges at site 82 with bellhousings 44 and 80, respectively, in such a way that the passagewaydefined by surface 117 merges distally with passageway 84. It should benoted that the longitudinal axis of passageway 84 and the longitudinalaccess of the passageway defined by wall surface 117 are substantiallyaligned with each other to accommodate ease of insertion of a slidableaspirating catheter tube 120, forming part of the aspirating cathetercartridge 116. Catheter tube 120 is flexible along its length toaccommodate smooth insertion through a tracheal tube, for example, intoeither lung of the patient for removal of secretions.

Wall 112 terminates in a blunt transverse proximal edge 122 and isformed as one piece with the other components of adapter 44, excludingswivel sleeves 88 and 88' and retainers 104. While not shown, edge 122may be slotted at 123 to receive a side port of cartridge 116.

The previously mentioned aspirating catheter cartridge or assembly 116comprises the mentioned aspirating catheter tube 120, illustrated asbeing of uniform thickness and inside and outside diameter throughout,and a distal fitting, generally designated 270. Fitting 270 comprises aslightly tapered distally-directed wall 272, shown as being in spacedrelation to and telescopic surrounding catheter tube 120, catheter tube120 being illustrated in FIG. 1 in a withdrawn state. A space or chamber274 exists between the exterior surface of the catheter tube 120 and theinterior surface 276 of wall 272. Wall 272 terminates at distal bluntedge 278. Inwardly-directed annular flange 278 defines a centralcircular opening at surface 280 through which tube 120 contiguouslythough slidably extends.

Wall 272 is interrupted by transverse opening 282, which is aligned withthe hollow interior of a transverse, relatively short hollow maleprojection 284. Projection 284 is formed as one piece with wall 272. Theattachment 150, connected to transverse tube 284, comprises a distalfitting, generally designated 180, which is L-shaped in configuration,as illustrated. A first hollow leg 182 of fitting 180 is force-fit overbarb 142 and around the exterior surface 143 of tube 284 as illustratedin FIG. 1. Leg 182 comprises a hollow interior 184 aligned with opening282 through which liquid may be selectively communicated. Fitting 180comprises a second hollow leg 186, disposed, as illustrated, atapproximately 90° in respect to leg 182. Leg 186 comprises a hollowinterior bore 188, disposed at approximately fight angles to passageway184 into which a distal end 190 of a flow accommodating tube 192 isplaced, either in a compression fit relation, or so as to be bonded orplastic welded in position. Tube 192 may be of any desired length.

Attachment 150 comprises, in addition, a proximal fitting, generallydesignated 200. Proximal fitting 200 comprises a distal boss 202, intowhich proximal end 194 of tube 192 is either force-fit or secured as byplastic welding, bonding, or the like. Boss 202 merges, at shoulder 204,into an enlarged annular wall 206. Communication between the hollowinterior at the proximal end 194 of tube 192 and the hollow interior 208within wall 206 is accommodated at orifice 210, the diameter of which isillustrated as being smaller than the inside diameter of tube 192. Wall206 is thicker at region 212, to accommodate connection of a tether 214so as to avoid risk that the tether 214 will become severed from thewall 206, with which it is formed initially as one piece. Tether 214connects at site 216 to a press-fit cap, generally designated 218. Cap218 comprises a proximal wall or flange 220, centrally thicker at 222 toaccommodate being press-fit into proximal opening 224 in the fitting200. The proximal wall 220 comprises an extension 226, which the usermay manually grasp to remove the cap 218 from its closed position, whichis illustrated in FIG. 1. Cap 218 also comprises an external annularcollar 228, the interior diameter of which is slightly less than theexterior diameter of wall 206, accommodating a press-fit union, whichcan be manually removed when desired, but will not inadvertentlyseparate.

Wall 206 defines a hollow interior cylindrical chamber surrounded byannular surface 208 in which a cylindrically shaped slit valve,generally designated 230, is disposed. In cross-section, slit valve 230is generally "I"-shaped, as seen in FIG. 1, and comprises an end-to-endlength substantially equal to the interior length of cylindrical wall208. Slit valve 230 may be formed of silicone rubber, KRATON™ siliconrubber, or the like, and comprises an annular wall 232 of uniformthickness throughout, as illustrated, comprising an external surface234, an internal surface 236, as well as blunt transversely disposeddistal and proximal edges 238 and 240.

A contoured radially-directed double dome-shaped central wall ordiaphragm 241 expands across and normally closes the space withininterior surface 236. Web or wall of diaphragm 230 is necked down at theannular site 242 where diaphragm 240 joins wall 232, as one piece,making annular site 242 the weakest part of wall 240, exclusive of oneor more central slits 244. Slit 244 may be of any desired size so as tobe capable of receiving a hollow male end of an instrument therethrough,which may be utilized to serve any number of purposes. For example,respiratory medication may be applied through a hollow male projectionphysically inserted through slit 244, through which the medication maybe dispensed under aerosol pressure or by manually-generally pressure,for example. The slit 244 is illustrated as being located both at thecenter of the slit valve 230 and in the region of greatest thickness ofwall 241. By providing a centrally thicker wall accompanied by aperipherally weakened wall, at 242, the periphery yields more readilyallowing somewhat of coordinated rotation in the wall at both theperiphery 242 and at slit 244 when a male projection is physicallyforced through and removed from the slit 244 both when there is pressureand when there is no pressure at the interior site of the diaphragm 241.Also, the double domed configuration of the diaphragm 241, with theenlarged lips at the slit 244 enhances a return to the normally closedstate upon removal of the male projection.

The attachment 150 of the aspirating catheter cartridge 116 may be usedto wash the exterior and interior surfaces of the catheter tube after itis withdrawn from the patient, saline or other suitable wash solutionbeing introduced by a hollow male projection extended through slit 244and thence along the hollow interior of attachment 150 of cathetercartridge 116 through opening 282 into chamber 274. The contiguousrelation between catheter tube 120 and tube 272 near edge 278 limitspassing of the wash solution into the chamber 118 and from thence intothe respiratory tract of the patient. Used wash solution is evacuatedthrough the hollow of the catheter tube 120 due to suction appliedthere. Also, lavage may be introduced through attachment 150, in themanner explained above, when the catheter tube 120 is fully or partiallyinserted, which lavage rum slowly down the catheter tube into therespiratory tract.

The distal fitting 270 comprises an exposed trailing or proximal annularflange 290, which, prior to assembly comprises a collar having a hollowinterior defined circumferentially by interior surface 292. Asheath-holding, tube wiper compression applying double wall collar,generally designated 294 is force-fit at its distal outside wall withinthe hollow interior of the collar 290, after an annular washer 296 isplaced within the hollow of the wall 290 so as to abut shoulder 291. Thedisk or wash, her 296 is preferably formed of yieldable syntheticresinous material, such as silicone rubber, and has an inside diameterat aperture-defining surface 298 so as to compressively engage theexterior surface of the catheter tube 120. Thus, the catheter tube 120is wiped by surface 298 as it is withdrawn from use in the respiratorysystem of an intubated medical patient, thereby removing secretions andother materials carried upon the exterior surface of the catheter tube120 and depositing the same in the wash chamber 274.

The double flange fitting 294 provides a certain amount of radiallycompressibility, which accommodates ready compression fit insertionwithin wall 290 with the forward edges of inside collar wall 295 and theoutside collar wall 299 holding washer 296 in the illustrated positionof FIG. 1 and aperture-defining surface 297 providing guidance to thecatheter tube as it is displaced.

In addition, the distal end 302 of a collapsible, preferablytransparent, plastic sheath, generally designated 304 is placed over thetrailing outside annular collar surface 300 of 295. Sheath end 302 isheld in compression-fit relationship by a collar 306 forced over theconcentrically disposed end 302 and flange surface 300.

The proximal end of the cartridge 116 comprises seriatim a proximalfitting 320 disposed at the end of the collapsible sleeve or envelope304, a normally closed suction valve, generally designated 322 and anexteriorally stepped tube, generally designated 324. Fitting 320 isillustrated as being formed as one piece from suitable syntheticresinous material and comprises a trailing or proximal collar 326, theexterior annular surface 328 of which is substantially the same diameteras the diameter of bore 330 forming a part of valve 322. The collar 326is secured in the position illustrated in FIG. 1 by plastic welding,bonding, or any other suitable fashion.

The hollow interior of collar 326, at radially-directed wall 327thereof, defines an aperture 332. Fitting 320 also comprises an annulardistally-extending interior flange 334, which defines a hollow interiorshown as having a uniform diameter extending to aperture 332, into whichthe trailing end 336 of catheter tube 120 is inserted and securedsuitably in the installed position by an appropriate bonding agent,plastic welding, or in any other suitable fashion.

Fitting 320 comprises an exterior, distally-directed flange 338, whichis radially spaced from flange 334. The trailing end 342 of thecollapsible sheath 304 is contiguously placed over the exterior surfaceof flange 338, over which a collar 344 is force-fit to retain the end342 in the assembled position.

When the normally closed valve 322 is manually depressed, negativepressure or suction is delivered from a suitable source along a suctiontube to the hollow interior of stepped tube 324 passes across valve 322,through hollow passageways therein, through aperture 332, and along thehollow interior of tube 120 when the distal end of the tube 120 issuitably positioned within a selected lung of the patient. As aconsequence, secretions accumulated in the lung are suctioned along thehollow interior of the tube 120 across aperture 332, the hollow interiorof the control valve 322 and thence through stepped tube 324.

The control valve 322 comprises a manually actuated reciprocableplunger, generally designated 350, a base plate 354, a female housingmember generally designated 356, and a single element elastomericmember, generally designated 358.

Plunger 350 comprises an oval-shaped exposed actuator 360, integrallyconnected to a rigid, vertically-oriented hollow tube 362, a flange end364 which is seated in a correspondingly-shaped recess 366 within thehollow interior of the single element 358. Female receptacle 356comprises a cavity 368, defined by an upwardly-directed oval-shapedflange 370 in which the plunger 350 reciprocates down and up,respectively, when actuator 360 is actuated and released. The femalereceptacle 356 comprises a distal passageway 372 and a proximalpassageway 374, which communicate one with the other across the singleelement 358 when the actuator 360 is depressed, by reason of thetear-shaped configuration of the single element 358. Element 358comprises a 360° reverse bend 376, an annular flange 377, and apear-shaped lower region, the diameter of which varies so that in the upposition, the single element 358 seals passageways 372 and 374preventing delivery of suction to the interior of the catheter tube 120.Flange 377 is anchored in the assembled position by a retainer 379 whichis bonded in the position illustrated in FIG. 1. In the down position,communication of negative pressure between passageways 372 and 374occurs around a reduced diameter part of the teardrop portion of theelement 358. Element 358 also serves to inhibit introduction ofatmospheric air into the valve because base plate 354 is sealed inposition. Element 358 also serves as its own spring, since the element358 is stretched in a downward direction as the actuator 360 isdepressed. Consequently, the memory of the element 358 causes the singleelement 358 to be returned to the sealed position illustrated in FIG. 1when manual force on actuator 360 is released.

Stepped tube 324 comprises exterior annular shoulders so that thestepped tube 324 may be inserted into and retained in medical gradetubing. Stepped tube 324 defines an interior bore in communication withbore 374 along which negative pressure is communicated selectively, asdescribed above.

At any desired point in time, the cartridge 116, with the catheter tube120 retracted, can be manually removed and discarded, following which afresh cartridge of similar or dissimilar design or purpose can beinserted into the female receptacle 117 defined by wall 112 to assist inproviding the appropriate therapy for the patient.

To improve the quality of health care available to intubated patients,it is important to avoid the possibility that ventilating tubing couldbe twisted and the availability to the patient of ventilating gaseseither occluded or materially reduced. To achieve this purpose, theswivel fitting provided by previously described rotatable tubes 88 and88' are provided. More specifically, bell housings 46 and 80 aretypically stationary during use, whereas connector tubes 88 and 88' arereadily rotated. Accordingly, when tube 88 is compression or otherwiseconnected to a tracheal tube, for example, the remainder of adapter 44may rotate as needed to relieve stress, without risking imposition oftorque on the tracheal tube. Similarly, when ventilating tubing isforce-fit upon or otherwise connected to tube 88', tube 88' may rotateas needed to relieve stress, prevent twisting of the ventilating tubing,and insure a continuing full supply of ventilating gases to theintubated patient.

It is to be appreciated that while the specific configuration comprisingadapter 44, illustrated and described in connection with FIG. 1,comprises a single distal port and a plurality of proximal ports, theswivel feature provided by tubes 88 and 88' may be utilized with anytype of ventilating fitting, for example the swivel connection maycomprise a tee-piece, an elbow, etc.

Other forms of adapters may comprise configurations other than an elbowwhich embody principles of the present invention.

The invention may be embodied in other specific forms without departingfrom the spirit of essential characteristics thereof. The presentembodiments are therefore to be considered in all respects asillustrative and are not restrictive, the scope of the invention beingindicated by the appended claims rather than by the foregoingdescription, and all changes which come within the meaning and range ofequivalency of the claims are therefore intended to be embraced therein.

An embodiment of the invention includes, but is not limited tomulti-port fitting for administering respiratory therapy to an intubatedmedical patient comprising an interiorly hollow main body, such as bellhousing 46. The hollow main body comprises a hollow distal part, such asdistal female bell housing 46. The hollow distal part defines a distalrespiratory flow path and a hollow proximal part, such as second bellhousing 80, defining at least one proximal respiratory flow path. Adistal tube is rotatably telescopically coupled to the hollow distalpart, such as sleeve 88, and a proximal tube, such as sleeve 88', isrotatably telescopically coupled to the hollow proximal part. At leastone if not both telescopic couplings comprise a longitudinally-directedrotatable union comprising a sealing structure which comprises at leasttwo spaced annular male ring shaped prongs 102 and 103, each prongextending into and being relatively rotatable within an annular femalegroove or blind slot 66 and 67.

Another embodiment of the invention is a swivel connection forpreventing twisting of a ventilating tube. The swivel connectioncomprises a first hollow fitting member, illustrated for example bysleeve 88, and a second hollow fitting member, illustrated by bell 46,telescopically overlapping the first hollow fitting member. Theconnection further comprises a swivel union that comprises at least twospaced annular axially-directed male rings, otherwise denoted as maleprongs 102 and 103, each snugly though relatively rotatably disposed ina matching annular axially-directed female groove or blind slot 66 and67.

Another embodiment of the invention includes connection for preventingtwisting of a ventilating tube. The connection comprises a first hollowfitting member, sleeve 88, and a second hollow fitting member, bell 46,telescopically overlapping the first hollow fitting member so that thehollows of the two members are in alignment to define a common flowpath. The connection further comprises a union that comprises (1)structure for preventing significant axial misalignment of the hollowsof the two members, (2) structure for preventing significant axialdisplacement of one member in respect to the other member, and (3)structure creating at least four radially juxtaposed sealing sites toprevent entry of atmospheric material between the two members intoeither hollow. The creating structure of the union comprises at leasttwo juxtaposed male rings 102 and 103 of one member each rotatablyseated contiguously in a female annular recess (blind slots 66 and 67)of the other member. Each of the male rings comprise a blunt edgecomprising two sealing sites. The creating structure to prevent entry ofatmospheric material may also comprise an annular sleeve in the natureof a bushing non-rotatably secured to one member comprising a bellhousing 4b. The bushing contiguously rotatably engages both a surface ofa male annulus, such as flange 105, and another surface area of theother member, sleeve 88.

Another embodiment of the invention is a closed system respiratoryadapter comprising structure defining a distal female receptaclecomprising a distal port 32, and structure defining at least twoproximal female receptacles 34 and 36, each comprising a proximal port.One of said proximal female receptacles 34 comprises wall structure forreceiving a distal end of a unitary aspirating catheter assembly inreleasibly, replaceable, compression-fit relation. The second of saidproximal female receptacles 36 comprises swivel wall structure forreceiving a distal end of yentilating tubing 89'. The distal femalereceptacle 32 and the second proximal female receptacle 36 eachcomprises swivel wall structure for releasible connection directly orindirectly to a tracheal tube 89. Each swivel wall structure comprisingat least two spaced seal members, or male prongs 102, to prevent entryof atmosphere across the swivel wall structure. The respiratory adaptermay have an elbow configuration.

Another embodiment of the invention is a closed tracheal assemblycomprising a hollow tracheal tube 89. The assembly comprises a distalend for placement in the respiratory tract and a proximal end forexternal availability. A hollow adapter 44 comprises a distal end bywhich the adapter is connected to the proximal end of the tracheal tubethrough port 32. The distal end of the adapter further comprising swivelstructure comprising at least two interfit relatively rotatablemale/female connections, i.e. male prongs 102 and 103 and female blindslots 66 and 67, each defining spaced anti-atmospheric infiltrationsealing sites.

Another embodiment of the invention is a closed tracheal assemblycomprising a hollow tracheal tube 89 comprising a distal end forplacement in the respiratory tract and a proximal end for externalavailability, and a hollow adapter 44 comprising a distal end by whichthe adapter is connected to the proximal end of the tracheal tube. Thedistal end of the adapter further comprises a proximal end through whicha ventilating gas is delivered to the respiratory tract, the proximalend swivel structure comprising at least two interfit relativelyrotatable male/female connections each defining spaced anti-atmosphericinfiltration sealing sites.

Another embodiment of the invention is a connection for preventingtwisting of a ventilating tube, the connection comprising a first hollowfitting member and a second hollow firing member telescopicallyoverlapping the first hollow fitting member so that the hollows of thetwo members are in alignment defining a common flow path. The connectionfurther comprises a union that comprises structure preventingsignificant axial misalignment of the hollows of the two members. Thestructure prevents significant axial displacement of one member inrespect to the other member and structure creating at least four spacedthrough radially juxtaposed sealing sites (20, 22, 24, and 26) betweenpairs of intermeshed male and female portions to prevent entry ofatmospheric material between the two members into either hollow.

What is claimed and desired to be secured by Letters Patent is:
 1. Anadaptor for coupling an intubated patient tube to exterior tubing,comprising:a main body portion defining a flow path therethrough that isadapted for providing fluid flow between an intubated patient tube andexterior tubing, said main body portion comprising a first end adaptedfor connection to the intubated patient tube and a second end adaptedfor connection to the exterior tubing; sleeve means for providing aswivel coupling for joining at least one of the intubated patient tubeand the exterior tubing to at least one of said ends of the main bodyportion, such that when joined the sleeve means is fully rotatable inany direction about its entire circumference without becomingdisconnected from the main body portion; and sealing means for providingan essentially hermetic seal between said fully rotatable sleeve meansand said at least one of said ends of the main body portion, saidsealing means comprising at least one continuously annular sealing ribmeans and an adjacent wall, with the rib means held in a continuouslyradially deflected position while said sleeve means is connected withsaid at least one of said ends of the main body portion so as to contactthe adjacent wall in order to form a sealing site with the adjacent wallwhen the rib means is deflected.
 2. An adaptor for coupling an intubatedpatient tube to exterior tubing as recited in claim 1 further comprisingcollar means for retaining said sleeve means so as to prevent separationof said sleeve means from the at least one of said ends of the main bodyportion.
 3. An adaptor for coupling an intubated patient tube toexterior tubing as recited in claim 1 wherein said sleeve means providesa swivel coupling for joining the intubated patient tube to said firstend of said main body portion and wherein said adaptor furthercomprising a second sleeve means for providing a swivel coupling forjoining the exterior tubing to said second end of said main bodyportion.
 4. An adaptor for coupling an intubated patient tube toexterior tubing as recited in claim 3 further comprising:a first collarmeans for retaining said sleeve means so as to prevent separation ofsaid sleeve means from said first end of said main body portion; and asecond collar means for retaining said second sleeve means so as toprevent separation of said sleeve means from said second end of saidmain body portion.
 5. An adaptor for coupling an intubated patient tubeto exterior tubing as recited in claim 1 further comprising barrel meansadapted for connection to catheter cartridge means.
 6. An adaptor forcoupling an intubated patient tube to exterior tubing as recited inclaim 1 wherein said sealing means comprises a plurality of sealing ribmeans and a plurality of adjacent walls, with the plurality of rib meansheld in a radially deflected position so as to contact at least one ofthe plurality of adjacent walls in order to form at least one sealingsite with said at least one of the plurality of adjacent walls when saidplurality of rib means is deflected.
 7. An adaptor for coupling anintubated patient tube to exterior tubing, comprising:a main bodyportion defining a flow path therethrough that is adapted for providingfluid flow between an intubated patient tube and exterior tubing, saidmain body portion comprising a first end adapted for connection to theintubated patient tube and a second end adapted for connection to theexterior tubing; first sleeve means for providing a swivel couplingjoined between the intubated patient tube and the first end of the mainbody portion, such that when joined the first sleeve means is fullyrotatable in any direction about its entire circumference withoutbecoming disconnected from the main body portion; second sleeve meansfor providing a swivel coupling joined between the exterior tubing andthe second end of the main body portion, such that when joined thesecond sleeve means is fully rotatable in any direction about its entirecircumference without becoming disconnected from the main body portion;and first sealing means for providing an essentially hermetic sealbetween said fully rotatable first sleeve means and said first end ofthe main body portion, and second sealing means for providing anessentially hermetic seal between said fully rotatable second sleevemeans and said second end of the main body portion, each of said sealingmeans comprising at least one continuously annular sealing rib means andan adjacent wall, with the rib means of said first sealing means held ina continuously radially deflected position while said first sleeve meansis connected with said first end of the main body portion so as tocontact the adjacent wall in order to form a sealing site with theadjacent wall when the rib means is deflected and with the rib means ofsaid second sealing means held in a continuously radially deflectedposition while said second sleeve means is connected with said secondend of the main body portion so as to contact the adjacent wall in orderto form a sealing site with the adjacent wall when the rib means isdeflected.
 8. An adaptor for coupling an intubated patient tube toexterior tubing as recited in claim 7 wherein the first sleeve meanscomprises a first swivel sleeve and wherein the second sleeve meanscomprises a second swivel sleeve.
 9. An adaptor for coupling anintubated patient tube to exterior tubing as recited in claim 8 whereinthe at least one sealing rib means comprises at least one sealing rib.10. An adaptor for coupling an intubated patient tube to exterior tubingas recited in claim 9 comprising barrel means adapted for connection tocatheter cartridge means.
 11. An adaptor for coupling an intubatedpatient tube to exterior tubing as recited in claim 10 comprising:afirst collar means for retaining said first sleeve means so as toprevent separation of said sleeve means from said first end of said mainbody portion; and a second collar means for retaining said second sleevemeans so as to prevent separation of said sleeve means from said secondend of said main body portion.
 12. An adaptor for coupling an intubatedpatient tube to exterior tubing as recited in claim 11 wherein saidbarrel means comprises a proximally extending barrel adapted forconnection to catheter cartridge means.
 13. An adaptor for coupling anintubated patient tube to exterior tubing as recited in claim 12 whereinsaid first collar means comprises a first annular collar received withinthe first end of the main body portion and wherein said second collarmeans comprises a second annular collar received within said second endof the main body portion.
 14. An adaptor for coupling an intubatedpatient tube to exterior tubing, comprising:a main body portion defininga flow path therethrough that is adapted for providing fluid flowbetween an intubated patient tube and exterior tubing, said main bodyportion comprising a first end adapted for connection to the intubatedpatient tube and a second end adapted for connection to the exteriortubing; a first swivel sleeve having one end joined to the intubatedpatient tube and having a second end joined to said first end of themain body portion, said joined ends of the first swivel sleeve and thebody portion together forming at least one continuously annular sealingrib and an adjacent wall, with the sealing rib held in a continuouslyradially deflected position while said first end of the main bodyportion and said first swivel sleeve are connected together so as tocontact the adjacent wall in order to form a sealing site with theadjacent wail when the sealing rib is deflected, such that when joinedthe first swivel sleeve is essentially hermetically sealed to the bodyportion and yet is still fully rotatable in any direction about itsentire circumference without becoming disconnected from the main bodyportion; and a second swivel sleeve having a first end joined to theexterior tubing and having a second end joined to said second end of themain body portion, said joined ends of the second swivel sleeve and thebody portion together forming at least one continuously annular sealingrib and an adjacent wall, with the sealing rib held in a continuouslyradially deflected position while said first end of the main bodyportion and said second swivel sleeve are connected together so as tocontact the adjacent wall in order to form a sealing site with theadjacent wall when the sealing rib is deflected, such that when joinedthe second swivel sleeve is essentially hermetically sealed to the bodyportion and yet is still fully rotatable in any direction about itsentire circumference without becoming disconnected from the main bodyportion.
 15. An adaptor for coupling an intubated patient tube toexterior tubing, comprising:a main body portion defining a flow paththerethrough that is adapted for providing fluid flow between anintubated patient tube and exterior tubing, said main body portioncomprising a first end adapted for connection to the intubated patienttube and a second end adapted for connection to the exterior tubing;sleeve means for providing a swivel coupling for joining at least one ofthe intubated patient tube and the exterior tubing to at least one ofsaid ends of the main body portion, such that when joined the sleevemeans is fully rotatable in any direction about its entire circumferencewithout becoming disconnected from the main body portion; and sealingmeans for providing an essentially hermetic seal between said fullyrotatable sleeve means and said at least one of said ends of the mainbody portion, said sealing means comprising a plurality of radiallyspaced continuously annular sealing sites formed by a plurality ofradially spaced matching continuous annular male and female sealingmembers, with at least one of said plurality of annular male and femalesealing members being in a continuously radially deflected positionwhile said sleeve means and said main body portion are connected.